Peg Kramer, AIC, CPCU April 11, 2017 6 min read

How to get the Best Claims Service from your Adjuster and Insurance Agency

Whether you are a large corporation or a business owner with five employees, when you have an injured worker you need help. You can look for assistance from your insurance agent and your workers compensation insurance carrier.

workplace injury

The process starts with you, the employer. All claims should be reported within 24 hours of notification from the injured worker or their supervisor.

The majority of workers compensation claims are medical-only claims.  This means that only medical treatment was required and there was no lost time at work. If your employee sought treatment with a medical provider, those claims must be submitted to your insurance carrier for payment.

Lost time claims are more complicated than medical-only claims and will directly affect your premium.  This is where you should be seeking assistance from your insurance agency claims department and your claims adjuster to get this matter reported, investigated, paid, and resolved as timely as possible.

If the claim is clearly a lost time claim, an adjuster from your insurance company should be calling you to introduce themselves and give you a claim number and their contact information. The adjuster may ask personal questions about your employee - remember that they do not know your employee, you do.  If this is a problem employee for you, they may be a problem for the insurance company as well.  Your adjuster needs to know as much about this person to properly handle the claim and understand what they are up against. 

It is at this time that you and the adjuster should be having a heart to heart discussion about what they expect from you and what you can expect from them:

  • Ask to receive a status call after every doctor’s appointment, so you know what is going on.  Your injured worker must bring in a work disability report outlining what they can and cannot do.  That in turn must be sent ASAP to the insurance company to keep benefits timely.
  • The adjuster should be telling you what the diagnosis is and what the doctor’s medical treatment plan will be to get this person ready to return to work. 
  • If your employee has a sprain or strain injury, the treating doctor will likely give temporary work restrictions. If you can accommodate the doctor’s restrictions at regular wages and hours, you may prevent this from becoming a lost time claim.  This is the best money saving tool you have available.
  • If your adjuster asks you for something, please comply as soon as possible.  Their purpose is to save you money.
  • You should be receiving timely responses from your adjuster if you email or call them – 24 to 48 hours is a reasonable response time.

If you are not receiving satisfactory service, Hausmann-Johnson Insurance has three dedicated claim counselors to assist you with any questions, concerns or scenarios about workers compensation.  Together we have over 75 years of experience in the claims industry and our purpose is to make this process as smooth as possible.  We work with your insurance carriers to obtain the most current information and plan of action to get the claim moving in the right direction. Together, our mutual goal is to have successful outcomes for you, our customer, in any claims situation.  We follow the majority of all lost time claims so that we are aware of what is happening.  If we see a resource that can help the claim along, we will contact the adjuster for discussion and keep you informed. 

If you have questions about this article and want to know ways we at Hausmann-Johnson can assist you in the claims process, please contact Susan Dorsch or Peg Kramer at 608-257-3795 for assistance.  Together, we can make a difference in your claims experience.

Would you like to learn more? Register for Peg's webinar, "Lifecycle of a Worker's Compensation Claim"

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Peg Kramer, AIC, CPCU

Peg found her way to Hausmann Group in 2014 over a serendipitous lunch with a former coworker. She uses her 20+ years of experience in the claims field to be a champion for clients when they are faced with difficult situations. Peg’s word is solid - she is tenacious and will go to great lengths to problem solve to provide the right answers. Peg believes that Wisconsin has the fairest and most equitable workers compensation program in the nation for both the employee and the employer. She prides herself in educating clients on what their options are under the program and how to prevent accidents, work with injured workers, and save money doing it. Peg grew up in her parent’s grocery store and was the first “Cart Greeter” ahead of the big box stores starting at age 4. She graduated from the University of Wisconsin - Platteville with Bachelor’s degrees in Criminal Justice and Psychology. On the weekends she loves to relax at her lake home in Oxford, Wisconsin or you can find her at garage sales, thrift shops and consignment stores learning the stories behind all of the interesting pieces for sale. She also actively volunteers at her church on the Parish Life Committee.